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Subclinical Thyroid Dysfunction In The First Trimester And Effects On Obstetric Outcomes

Year 2016, Volume: 13 Issue: 4, 143 - 147, 01.10.2016

Abstract

Aim: To investigate the relationship between subclinical thyroid disfunctions and Hashimoto thyroiditis and adverse pregnancy outcomes in early pregnancy.Material and Methods: In this study 288 pregnant women who were examined at Medeniyet University Goztepe Education and Research Hospital Obstetrics and Gynecology Department were included. All cases were classified as subclinical hypothyroidism, subclinical hypertiroidism and euthyroidism according to their thyroid function tests. Cases with positive thyroid auto antibody tests were considered as Hashimoto thyroiditis and classified to subclinical hypothyroidism and euthyroidism subgroups. Adverse pregnancy outcomes were defined as first trimester pregnancy loss, preterm delivery, preeclampsia, gestational hypertension, gestasional diabetes, premature rupture of membranes , small for gestasyonel age and neonatal intensive care needs.Results: In this study euthyroidism ,subclinical hyperthyroidism and subclinical hyperthyroidism were 75.3%, 19.4%, 5.2% , respectively. Adverse pregnancy outcomes were occured in 32.1% of subclinical hypothroid 18/56 and 24.9% of euthyroid 54/217 patients. Neonatal intensive care need was found 43.8% 20/56 and 29.5% 61/217 at subclinical hypothroidism and euthyroid groups, respectively p>0,05 . Neonatal intensive care need was found 63.6% and 43.2% at subclinical hypothyroidism and euthyroidism subgroups of Hashimoto’s thyroiditis, respectively p=0,009 . Comparisons were performed to determine the group make all the difference. Neonatal intensive care need in subclinical hypothyroidism subgroup of Hashimoto’s thyroiditis was higher than euthyroid group p = 0.041 .Conclusion: Subclinical thyroid dysfunction in the first trimester of pregnancy was not associated with adverse pregnancy outcomes. Subclinical hypothyroidism with Hashimoto thyroiditis was associated with increased neonatal intensive care unit need.

References

  • Lazarus JH. Thyroid function in pregnancy. Br Med Bull. 2011;97:137- 48.
  • Li C, Shan Z, Mao J, Wang W, Xie X, Zhou W, et al. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women? J Clin Endocrinol Metab. 2014;99:73-9.
  • Poppe K, Velkeniers B, Glinoer D. The role of thyroid autoimmunity in fertility and pregnancy. Nat Clin Pract Endocrinol Metab. 2008;4:394- 405.
  • Colicchia M, Campagnolo L, Baldini E, Ulisse S, Valensise H, Moretti C. Molecular basis of thyrotropin and thyroid hormone action during implantation and early development. Hum Reprod Update. 2014;20:884- 904.
  • Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31:702-55.
  • Mannisto T, Mendola P, Grewal J, Xie Y, Chen Z, Laughon SK. Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort. J Clin Endocrinol Metab. 2013;98:2725-33.
  • Mannisto T, Mendola P, Reddy U, Laughon SK. Neonatal outcomes and birth weight in pregnancies complicated by maternal thyroid disease. Am J Epidemiol. 2013;178:731-40.
  • Mannisto T, Vaarasmaki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM, et al. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J Clin Endocrinol Metab. 2009;94:772-9.
  • Karakosta P, Alegakis D, Georgiou V, Roumeliotaki T, Fthenou E, Vassilaki M, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab. 2012;97:4464-72.
  • Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen. 2000;7:127-30.
  • American College of O, Gynecologists, Task Force on Hypertension in P. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122-31.
  • Mathews TJ, Menacker F, MacDorman MF, Centers for Disease C, Prevention NCfHS. Infant mortality statistics from the 2002 period: linked birth/infant death data set. Natl Vital Stat Rep. 2004;53:1-29.
  • ACOG Committee Opinion No 579: Definition of term pregnancy. Obstet Gynecol. 2013;122:1139-40.
  • Rosenfeld H, Ornoy A, Shechtman S, Diav-Citrin O. Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study. Br J Clin Pharmacol. 2009;68:609-17.
  • Thorpe-Beeston JG, Nicolaides KH, Snijders RJ, Felton CV, McGregor AM. Thyroid function in small for gestational age fetuses. Obstet Gynecol. 1991;77:701-6.
  • Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21:1081-125.
  • Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3:76-94.
  • Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008;112:85-92.
  • Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol. 2006;107:337-41.
  • Wilson KL, Casey BM, McIntire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol. 2012;119:315-20.
  • Negro R, Stagnaro-Green A. Diagnosis and management of subclinical hypothyroidism in pregnancy. BMJ. 2014;349:4929.
  • Carle A, Laurberg P, Pedersen IB, Knudsen N, Perrild H, Ovesen L, et al. Epidemiology of subtypes of hypothyroidism in Denmark. Eur J Endocrinol. 2006;154:21-8.
  • Çakır N. Gebelik ve tiroid hastalıkları. Türkiye Klinikleri J Endocrin. 2004;2:65-72.
  • Moreno-Reyes R, Glinoer D, Van Oyen H, Vandevijvere S. High prevalence of thyroid disorders in pregnant women in a mildly iodine- deficient country: a population-based study. J Clin Endocrinol Metab. 2013;98:3694-701.
  • Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ. 2011;342:2616.
  • Korevaar TI, Schalekamp-Timmermans S, de Rijke YB, Visser WE, Visser W, de Muinck Keizer-Schrama SM, et al. Hypothyroxinemia and TPO- antibody positivity are risk factors for premature delivery: the generation R study. J Clin Endocrinol Metab. 2013;98:4382-90.
  • Ozdemir H, Akman I, Coskun S, Demirel U, Turan S, Bereket A, et al. Maternal thyroid dysfunction and neonatal thyroid problems. Int J Endocrinol. 2013;2013:987843.
  • Liu H, Shan Z, Li C, Mao J, Xie X, Wang W, et al. Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study. Thyroid. 2014;24:1642-9.
  • Sezer K, Kamel N, Unlu C, Celik HK. Impact of first trimester and postpartum period thyroid autoantibodies on abortus incidence in Turkish pregnant women. Gynecol Endocrinol. 2009;25:387-91.

İlk Trimester Gebeliklerde Subklinik Tiroid Fonksiyon Bozuklukları ve Obstetrik Sonuçlar Üzerine Etkisi

Year 2016, Volume: 13 Issue: 4, 143 - 147, 01.10.2016

Abstract

Amaç: Gebeliğin birinci trimesterinde saptanan subklinik tiroid fonksiyon bozukları ve Hashimoto tiroiditininin olumsuz gebelik sonuçları ile ilişkisinin araştırılması.Gereç ve Yöntemler: Çalışmaya, İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği Gebe Polikliniği’ne başvuran 288 gebe dahil edildi.Olgular tiroid fonksiyon testlerine göre, subklinik hipotiroid, subklinik hipertiroid ve ötiroid gruplarına ayrıldı.Tiroid otoantikor testi pozitif olan olgular Hashimoto tiroiditi olarak değerlendirildi ve tiroid fonksiyon testlerine göre ötiroid , sublinik hipotiroidi alt grupları oluşturuldu. Birinci trimester gebelik kaybı, preterm doğum, preeklampsi, gestasyonel hipertansiyon, gestasyonel diyabet, erken membran rüptürü, gebelik yaşına göre düşük doğum ağırlığı ve yenidoğan yoğun bakım ihtiyacı mevcut gebelikte kötü obstetrik sonuçlar olarak belirlendi. Yukarıda belirlenen gruplar ile bu obstetrik sonuçlar arasındaki ilişki araştırıldı.Bulgular: Olguların %75,3’ü ötiroidik, %19,4’ü subklinik hipotiroidik ve %5,2 ‘si subklinik hipertiroidik idi.Subklinik hipotiroidi olgularının %32,1’inde 18/56 ; ötiroidi olguların %24,9’unda 54/217 kötü obstetrik sonuç gelişti p>0,05 . Yenidoğan yoğun bakım ihtiyacı subklinik hipotiroidi ve ötiroidi grubunda %43,8 20/56 ve %29,5 61/217 oranında bulundu p>0,05 . Yenidoğan yoğun bakım ihtiyacı Hashimoto tiroiditli subklinik hipotiroidi grubunda %63.6 ve Hashimoto tiroiditli ötiroidi grubunda %43.2 oranında bulundu p=0,009 . Farklılığı yaratan grubu belirlemek amacıyla ikili karşılaştırmalar yapıldı. Yenidoğan yoğun bakım ihtiyacı subklinik hipotiroidik Hashimoto tiroidi olgularda ötiroid gebelerden yüksek bulundu p=0,041 .Sonuç: Gebeliğin birinci trimesterindeki subklinik tiroid fonksiyon bozuklukları kötü obstetrik sonuçları ile ilişki bulunmadı. Hashimoto tiroidit varlığında subklinik hipotiroidi yenidoğan yoğun bakım ünitesi ihtiyacında artışla ilişkilidir.

References

  • Lazarus JH. Thyroid function in pregnancy. Br Med Bull. 2011;97:137- 48.
  • Li C, Shan Z, Mao J, Wang W, Xie X, Zhou W, et al. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women? J Clin Endocrinol Metab. 2014;99:73-9.
  • Poppe K, Velkeniers B, Glinoer D. The role of thyroid autoimmunity in fertility and pregnancy. Nat Clin Pract Endocrinol Metab. 2008;4:394- 405.
  • Colicchia M, Campagnolo L, Baldini E, Ulisse S, Valensise H, Moretti C. Molecular basis of thyrotropin and thyroid hormone action during implantation and early development. Hum Reprod Update. 2014;20:884- 904.
  • Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31:702-55.
  • Mannisto T, Mendola P, Grewal J, Xie Y, Chen Z, Laughon SK. Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort. J Clin Endocrinol Metab. 2013;98:2725-33.
  • Mannisto T, Mendola P, Reddy U, Laughon SK. Neonatal outcomes and birth weight in pregnancies complicated by maternal thyroid disease. Am J Epidemiol. 2013;178:731-40.
  • Mannisto T, Vaarasmaki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM, et al. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J Clin Endocrinol Metab. 2009;94:772-9.
  • Karakosta P, Alegakis D, Georgiou V, Roumeliotaki T, Fthenou E, Vassilaki M, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab. 2012;97:4464-72.
  • Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen. 2000;7:127-30.
  • American College of O, Gynecologists, Task Force on Hypertension in P. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122-31.
  • Mathews TJ, Menacker F, MacDorman MF, Centers for Disease C, Prevention NCfHS. Infant mortality statistics from the 2002 period: linked birth/infant death data set. Natl Vital Stat Rep. 2004;53:1-29.
  • ACOG Committee Opinion No 579: Definition of term pregnancy. Obstet Gynecol. 2013;122:1139-40.
  • Rosenfeld H, Ornoy A, Shechtman S, Diav-Citrin O. Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study. Br J Clin Pharmacol. 2009;68:609-17.
  • Thorpe-Beeston JG, Nicolaides KH, Snijders RJ, Felton CV, McGregor AM. Thyroid function in small for gestational age fetuses. Obstet Gynecol. 1991;77:701-6.
  • Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21:1081-125.
  • Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3:76-94.
  • Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008;112:85-92.
  • Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol. 2006;107:337-41.
  • Wilson KL, Casey BM, McIntire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol. 2012;119:315-20.
  • Negro R, Stagnaro-Green A. Diagnosis and management of subclinical hypothyroidism in pregnancy. BMJ. 2014;349:4929.
  • Carle A, Laurberg P, Pedersen IB, Knudsen N, Perrild H, Ovesen L, et al. Epidemiology of subtypes of hypothyroidism in Denmark. Eur J Endocrinol. 2006;154:21-8.
  • Çakır N. Gebelik ve tiroid hastalıkları. Türkiye Klinikleri J Endocrin. 2004;2:65-72.
  • Moreno-Reyes R, Glinoer D, Van Oyen H, Vandevijvere S. High prevalence of thyroid disorders in pregnant women in a mildly iodine- deficient country: a population-based study. J Clin Endocrinol Metab. 2013;98:3694-701.
  • Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ. 2011;342:2616.
  • Korevaar TI, Schalekamp-Timmermans S, de Rijke YB, Visser WE, Visser W, de Muinck Keizer-Schrama SM, et al. Hypothyroxinemia and TPO- antibody positivity are risk factors for premature delivery: the generation R study. J Clin Endocrinol Metab. 2013;98:4382-90.
  • Ozdemir H, Akman I, Coskun S, Demirel U, Turan S, Bereket A, et al. Maternal thyroid dysfunction and neonatal thyroid problems. Int J Endocrinol. 2013;2013:987843.
  • Liu H, Shan Z, Li C, Mao J, Xie X, Wang W, et al. Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study. Thyroid. 2014;24:1642-9.
  • Sezer K, Kamel N, Unlu C, Celik HK. Impact of first trimester and postpartum period thyroid autoantibodies on abortus incidence in Turkish pregnant women. Gynecol Endocrinol. 2009;25:387-91.
There are 29 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Sedef Kabaca This is me

Halenur Bozdağ This is me

Fatma Bilge Selvi Öğütçüoğlu This is me

Fulya Gökdağlı This is me

Hacer Kavak This is me

Necati Cihan Tanyolaç This is me

Publication Date October 1, 2016
Published in Issue Year 2016 Volume: 13 Issue: 4

Cite

Vancouver Kabaca S, Bozdağ H, Öğütçüoğlu FBS, Gökdağlı F, Kavak H, Tanyolaç NC. İlk Trimester Gebeliklerde Subklinik Tiroid Fonksiyon Bozuklukları ve Obstetrik Sonuçlar Üzerine Etkisi. JGON. 2016;13(4):143-7.